TOM FINNEGAN / TFINNEGAN@STARBULLETIN.COM
Kauai nurses celebrated outside Wilcox Hospital on Oct. 27 after the nurses' 18-week strike came to an end. Despite staffing levels being replenished, a community group says problems at the facility, which is currently being investigated by the state, persist.

Group demands hospital inquiry

The company running Wilcox is accused of being driven by the bottom line

A group of residents says there are still problems at Kauai's lone full-service hospital and its affiliated clinics, although the nurses union says it is working for safe staffing levels after a four-month strike.

The group of over a dozen residents, including retired doctors and the former chief executive officer of the hospital, have petitioned the state oversight agency and the attorney general to investigate Wilcox's administration, now handled by Hawaii Pacific Health.

They say the company, formed in 2001 when Wilcox and its clinics merged with Kapiolani Medical Centers and Straub Clinic and Hospital, is more concerned with the bottom line than patients, leading to the exodus of a number of doctors and nurses, as well as other problems.

The residents say patients are paying more money for services and have fewer options in terms of doctors in specialized medicine. And they say HPH is providing less care to the underinsured, disadvantaged and uninsured.

The attorney general and the state Health Planning and Development Agency are looking into the hospital's Certificate of Need.

While the Attorney General's Office did not return calls for comment, Dr. David Sakamoto, administrator for SHPDA, said this week that their "fact-finding" investigation is proceeding with full cooperation from the hospital and HPH. He would not, however, give a timetable for the investigation.

As for the administration, HPH Executive Vice President Ray Vara said this week that Wilcox's merger with HPH has been beneficial for Kauai's patients and continually puts the Garden Isle's health care needs first.

"We think the accusations are unfounded," Vara said. "We are confident we can answer any questions raised."

The problem for the Kauai citizens group, called the Concerned Citizens for Kauai's Healthcare Future, is that Garden Isle residents have few other options other than HPH. In addition to Wilcox, HPH also provides administrative services for Kauai Medical Clinic, a separate nonprofit organization of local clinics affiliated with the hospital.

So between the clinic and the hospital, 80 percent to 85 percent of Kauai patients receive care from HPH-run facilities, said Doug Wilmore, a spokesman for the citizens group.

The group's main concerns lie with an administration that, they say, has sold portions of the hospital's assets, charged exorbitant fees for administrative functions and taken control of the day-to-day management of the hospital.

According to letters sent to the state agencies and provided to the Star-Bulletin, the group alleges that HPH deliberately misled the public by underestimating administrative costs by as much as $10 million a year.

They also say that, despite pledging to keep the same number of beds, HPH sold the long-term care center, or 60 percent of the hospital's beds. It also sold the laboratory to a for-profit entity owned by Kapiolani, which is, in turn, run by HPH.

Dr. William Evslin, former chief executive officer of Wilcox and a member of the citizens group, said none of the profits from the two sales went to Wilcox.

The group also claims that despite committing to provide better clinical services, Kauai has no board-certified physicians in the fields of cardiology, gastro-enterology or oncology, forcing patients to go to Oahu for treatment.

Wilmore said the hospital had learned, over the years before the merger, how to balance the needs of the community and still run a successful hospital.

But "that formula, that balance," has been damaged, Wilmore said. "Our long-term goal is to see how we can right the apple cart."

The state's Sakamoto said its investigation, which is "nearly finished," was prompted both by the group's concerns and a request by the Kauai County Council to look into HPH at Wilcox.

Rescinding the Certificate of Need "is very unlikely at this point," Sakamoto said. Sakamoto did say, however, that SHPDA and the attorney general want to "improve things, if we can," although the statute is very limited in its scope.

Vara said it's also HPH's goal to provide top-rate care on Kauai by giving the hospitals the ability to focus on patient care. HPH is "a corporate structure," Vara said, supplying the four hospitals under its charge with information systems, a legal department, billing and human resources.

"The reasons for the merger are the same as in 2001," Vara said. By combining all their resources, the hospitals have been able get top-rate talent, techniques and equipment in place to help patients.

But Vara said HPH understands that Kauai is "a separate and distinct community." That's why there's another level of management at Wilcox and at the Kauai Medical Clinic to provide support.

As for the specific concerns, Vara said it's always been clear what the administration would cost, and, he added, it's comparable to mainland administrative costs. When asked about the number of doctors leaving, he said HPH has a "reasonable industry turnover."

Administrative decisions, Vara said, are left to the Wilcox Hospital board of directors. It was the board that agreed to sell both the long-term care beds and the lab.

"We're behaving consistently with the intent of the sale and the commitments of the sale," he said.